Gastroenteritis

Gastroenteritis:

  • IV fluids: NS @ 150cc/hr X 2L (why this specifically?)
  • Zofran or Phenergan PRN for N/V.
  • Lomotil PRN for Diarrhea
    1. Lomotil 2.5mg 1-2 tabs PO bid-qid PRN for Diarrhea [Take with food to decrease GI upset.]
    2. Mechanism of action: inhibits peristalsis of intestinal muscles
  • Diet: Clear liquids and advance as tolerated.
  • If diarrhea: Order stool studies: ova & parasite, C. diff (esp if recent antibiotic use), lactoferrin (WBC), FOBT.

Gastroenteritis:

  • Assess for: recent travel, recently taken any antibiotics, recently camped, and known sick contacts

Treat nausea/vomiting:

  • Zofran (Ondansetron) 2-8mg PO/IV q6-8hrs PRN for N/V [Do NOT use if prolonged QT interval!]
  • Phenergan (Promethazine) 12.5-25mg IV/PO/PR/IM q4-6hr PRN for N/V
    • Phenergan gel (compound) – apply to skin PRN N/V

Treat Diarrhea:

  • Lomotil 5mg 2 tabs PO 4 times per day PRN for Diarrhea [Take with food to decrease GI upset.]
    • Controlled substance
  • Imodium (Loperamide) 2mg PO – take 2 tablets initially followed by 1 tablet after each loose BM (do not exceed 8 tablets/day)
    • Not controlled substance
  • Diet: Clear liquids and advance as tolerated.
  • If diarrhea lasts over 1 week or if suspicious history:
    • Order stool studies: ova & parasite, C. diff (esp if recent antibiotic use), lactoferrin (WBC), FOBT.

Recommend drinking plenty of fluid, especially fluids with electrolytes such as Gatorade-type beverages. This is likely gastroenteritis (“stomach bug”), which is most commonly caused by a viral infection and will resolve on its own with supportive management.

  • Have patient return to the clinic in 1 week though to assess whether the symptoms have resolved. If they have not, further work up is warranted.

Ex plan:

  1. Diarrhea: Continue taking Imodium since this has been effective in decreasing the diarrhea.
  2. Nausea/Vomiting: Zofran prescribed to take PRN.

Recommend drinking plenty of fluid, especially fluids with electrolytes such as Gatorade-type beverages. This is likely gastroenteritis, which is most commonly caused by a viral infection and will resolve on its own with supportive management.

Gastroenteritis with vomiting and diarrhea: At this time, the likely etiology of her symptoms is viral. The patient is encouraged to stay well hydrated. She is prescribed Phenergan gel to mitigate her nausea and vomiting. The patient is to return to the clinic in 1 week if her symptoms have not resolved by that time. Diarrhea persisting beyond a week warrants further work up: Order stool studies: ova & parasite, C. diff, lactoferrin (WBC), FOBT. Patient does not have anything suspicious in her history, so these tests will be deferred for now.

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